Abstract
In the opening sentence of his Foreword to this book, Dr Stewart Tepper states that the “overlap between the disciplines of pain management, headache medicine, and surgery allows for the opportunity to optimize treatment for patients with head and face pain”. Dr Samer Narouze embodies that overlap, and has attempted to draw together experience and expertise in all three areas to provide a novel textbook of interventional therapies for headache and facial pain disorders. The result is a book of 20 chapters divided into five sections: indications for interventional management; nerve blocks for head and face pain; cervicogenic headache; other common interventions for headaches (including onabotulinum toxin); and neuromodulation for head and face pain.
As perhaps is inevitable in a first iteration of such a project, the result is a “curate’s egg” of a book: Good in parts, but hamstrung by a lack of central purpose, uneven editing, and sloppy subediting (one loses confidence when the name of the author of the first reference in the first chapter is incorrect, for example). The potential value of the project – to bring together specialists from disparate fields in the management of patients with complex pain disorders – is also its weakness. Headache experts will, I suspect, find the initial section on “indications for interventional management” and, in particular, the algorithms for the diagnosis and management of head pain, overly simplistic. The latter chapter promises to “review different proposed algorithms to guide practitioners to make a precise diagnosis” but in fact merely presents five algorithms with no supporting comment or evidence.
Lack of evidence pervades much of the book, but this is of course not entirely the fault of the authors. The evidence base underlying most interventions, particularly when used for primary headache disorders rather than nerve-specific neuralgia or neuropathy, is weak. Mays and Tepper’s chapter on occipital nerve blocks is one of the few to attempt to summarise the totality of the evidence; further studies, recently published, now exist on the efficacy or otherwise of this intervention in migraine. Where better quality evidence does exist, it is either underplayed (in the chapters on trigeminal neuralgia and occipital nerve stimulation, for example) or not quoted at all (for example, Jim Nagy’s 2011 study of the inpatient management of over 150 patients with disabling headache with IV dihydroergotamine, published in Neurology, is not cited at all in the chapter on infusion therapies).
As a neurologist with an interest in headache disorders, I found the section on cervicogenic headache most useful, particularly Narouze’s chapter on a “practical approach to cervicogenic headache”. This has of course been, and continues to be, a highly controversial area of headache medicine, but anyone who deals day in, day out with these patients knows that problems in the neck are common, and that interventions to deal with pain arising from pain-sensitive structures in the neck are an important part of a holistic approach to management of many patients with chronic headaches.
Overall, therefore, this book would be a useful addition to any departmental neurology library (if such things still exist), for both those with an interest in headache, and those for whom headache is merely part of a general neurological practice, who may find information that will help them understand their patients better, and perhaps guide a more fruitful conversation with colleagues in pain medicine and neurosurgery. There is no other book like this, and perhaps its value rests in its mission – to bring together specialists from disparate fields. A second edition would be highly welcome, both to include new insights from this rapidly developing field, and to allow some judicial editing to smooth out its rough edges and uneven surfaces.
Mark W Weatherall
Princess Margaret Migraine Clinic, Charing Cross Hospital, London, UK